transvaginal drainage transvaginal probe set up drainage of abscess...tubo-ovarian abscess...
TRANSCRIPT
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TRANSVAGINAL DRAINAGETubo-Ovarian Abscess
TRANSVAGINAL DRAINAGE
Needle Aspiration
Transvaginal DrainageTransvaginal Probe
Set Up
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Anatomic Issues
Bowel Vessels
Rectum Transgluteal
Collection
Transgluteal Drainage
Less complicated than you think
Less painful than you thinkAllows more options for
drainageUnderutilized
TRANSGLUTEAL Anatomic Consideratons
Sciatic
TRANSGLUTEALAvoid Bowel
Bowel
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Transgluteal Technique
Access route
chosenNeedle placed
LIVER ABSCESSAntibiotics Work
Pre Treatment Post Treatment
DIVERTICULITIS DIVERITICULITIS
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Elderly patient Pallaitive
Co-morbid disease Controversial
Appendiceal Drainage
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Left Subphrenic
Barium –6 weeks post drainage
CROHN’S DRAINAGE
CROHN’S DRAIANGE
No FistulaCROHN’S DISEASE
No Fistula
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Appendiceal Drainage
DIVERTICULITIS
Staging
DIVERTICULITISHealing Communication
Initial Injection
3 Weeks Later
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TROCAR TECHNIQUENot Always Easy CROHN’S DISEASE
DIVERTICULITISDifferential vs Tumor
Diverticulitis vs TumorCROHN’S DISEASE
Fistula with Colon
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CROHNSCommunication to Colon
DIVERTICULAR DRAINAGEWhy ?
1) Allow single stage surgery
2) Temporize ill patients
3) Downstage surgical stage
4) Does not preclude surgery
CROHN’S DRAINAGEWhy ?
1) Reduce operations
2) Make operations easier
3) Possible temporary cure
4) Fistulas common,but curable
Appendiceal Drainage
Pre-Irrigation Post-Irrigation
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Diverticular Abscess
Diverticular Abscess
One Week
What Access Route ?
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Diverticulitis vs Tumor Multiple AbscessesMultiple Approaches
Multiple Approaches Trocar Technique
Trocar TechniqueDIVERTICULITIS
Trocar Technique
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DIVERTICULITISFistula Connection Diverticulitis
1) Drainage palliative prior to surgery
2) Fistula to colon common 3) Patient –home with catheter4) Catheter may remain in for
weeks
Standard Abscess DrainageSTANDARD ABSCESS DRAINAGE
Routine Questions
Access route
Follow up – Clinical
Drainage over time
Fistula communication
Cure Expectations
Appendicitis Appendicitis
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Diverticulitis Diverticulitis
SUBPHRENIC ABSCESS2ND Manipulation
Value of 2nd
Manipulation
SUBPHRENICIncomplete Drainage
Tandem Technique
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SUBPHRENIC ABSCESSUS/Fluoro – Multihole Catheter
Subcostal
Large surface area
Subphrenic Abscess
Transgluteal Drainage Appendicitis
POST WHIPPLEAnastamotic Leak
No obstruction: Drain abscess and leak will close
Multiple CathetersMultiple Abscesses
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Multiple AbscessesMultiple Catheters
Infected HematomaWhy Failed Drainage?
CATHETER CHOICES
12 Fr
10 Fr
16 Fr
Trocar Technique
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Multiloculated Abscess
Whither Catheter Injection ?
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How do I tell that I have an abscess ?
SAFE ACCESS ROUTEWhere is the Bowel?
Where is the Bowel ? Identify the Bowel
Fistula Communicaton
Amount of drainage / Time
Character of drainage
Imaging shows no collection
Long term catheter drainage
Patience
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